A new clinical trial seems to show that a specific form of early intervention can reduce the risk of children developing autism spectrum disorder (ASD) as they get older. The study found high-risk infants whose parents were given the intervention went on to have lower rates of being clinically diagnosed with ASD by the time they turned three, compared to families given standard care. Though only a single study, and relatively small, the results may point to a genuine step forward in autism research if further validated.
ASD is a complicated condition, both in its suspected causes and symptoms. Genetics and environmental influences, like air pollution exposure during pregnancy or early infancy, are thought to be important risk factors. Symptoms of ASD can range in severity and presentation but tend to include developmental delays, problems with social interaction, repetitive behaviours, sensitivity to touch, light, and sound, and digestive issues. According to the Centres for Disease Control and Prevention, about one in 54 children born today develop ASD.
Scientists have gotten closer to untangling the risk factors of ASD and have ruled out others (like childhood vaccines) in recent years. And there are several treatments available for people living with ASD, such as speech therapy, social skills training, and programs to help children improve their developmental learning. But to date, there are no known ways to prevent or reduce the severity of ASD in high-risk individuals before a formal diagnosis is made.
The study was conducted by researchers in Australia and the UK, who have been working on a program for families at risk of having children develop ASD. They call it the iBASIS–Video Interaction to Promote Positive Parenting, or iBASIS-VIPP. The intervention claims to teach parents how best to support and respond to their children’s existing behaviour in positive ways, rather than trying to steer them away from behaviours seen as inappropriate, as some past attempts to prevent or treat ASD have done. After an initial training course, parents get feedback from their trained counselors, who watch how they interact with their children on video.
Earlier research of theirs had suggested that iBASIS-VIPP could help children. But their new study, published this week in JAMA Pediatrics, is intended to be the first large enough to show a clear benefit in a randomised trial setting, often considered the gold standard of scientific evidence.
They recruited the families of 103 infants between the ages of 9 and 14 months who showed early signs of being at risk for ASD on developmental tests. Then they randomised the families into two groups: one that went through a 12-month iBASIS-VIPP program in addition to the standard care that families in this situation are offered, and one that only received standard care for children at risk of ASD. This standard care can include a range of interventions like information seminars or community therapy. Though the families themselves knew which group they were in, the medical providers evaluating whether the children went on to develop ASD were blinded, meaning they didn’t know.
By age 3, about 7% of children in the intervention group were diagnosed with ASD, compared to about 21% in the control group.
“The use of iBASIS-VIPP resulted in three times fewer diagnoses of autism at age three,” said study author Andrew Whitehouse, a professor of autism research at Telethon Kids Institute and the University of Western Australia, in a statement from the university. “No trial of a pre-emptive infant intervention, applied prior to diagnosis, has to date shown such an effect to impact diagnostic outcomes — until now.”
Though the trial’s findings look impressive, they are still based on a small sample size (for context, Phase III trials of an experimental drug tend to involve hundreds of volunteers at a minimum). It’s also important to note that iBASIS-VIPP isn’t meant to be a cure for autism, nor are the researchers advertising it as such.
Overall, there were no differences between the groups in how many children showed signs of atypical development, based on the tests they took — only in how often they met the criteria for ASD. In other words, the intervention may have reduced the severity of developmental problems these children could experience but not wholly prevented them. But the authors say that’s still a worthwhile goal.
“The children falling below the diagnostic threshold still had developmental difficulties, but by working with each child’s unique differences, rather than trying to counter them, the therapy has effectively supported their development through the early childhood years,” Whitehouse said.
Ideally, studies from other researchers will be able to replicate the results seen here. Another important test will be whether these changes hold up over time and lead to fewer issues as the children grow up. To that end, the researchers are planning follow-up studies that will track these children.
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